Presurgical video-EEG monitoring with foramen ovale and epidural peg electrodes: a 25-year perspective.

Background: Epilepsy surgery cases are becoming more complex and increasingly require invasive video-EEG monitoring (VEM) with intracranial subdural or intracerebral electrodes, exposing patients to substantial risks. We assessed the utility and safety of using foramen ovale (FO) and epidural peg electrodes (FOP) as a next step diagnostic approach following scalp VEM.

Methods: We analyzed clinical, electrophysiological, and imaging characteristics of 180 consecutive patients that underwent FOP VEM between 1996 and 2021.

Drug resistance in cortical and hippocampal slices from resected tissue of epilepsy patients: no significant impact of p-glycoprotein and multidrug resistance-associated proteins.

Drug resistant patients undergoing epilepsy surgery have a good chance to become sensitive to anticonvulsant medication, suggesting that the resected brain tissue is responsible for drug resistance. Here, we address the question whether P-glycoprotein (Pgp) and multidrug resistance-associated proteins (MRPs) expressed in the resected tissue contribute to drug resistance in vitro. Effects of anti-epileptic drugs [carbamazepine (CBZ), sodium valproate, phenytoin] and two unspecific inhibitors of Pgp and MRPs [verapamil (VPM) and probenecid (PBN)] on seizure-like events (SLEs) induced in slices from 35 hippocampal and 35 temporal cortex specimens of altogether 51 patients (161 slices) were studied.

KOMET: an unblinded, randomised, two parallel-group, stratified trial comparing the effectiveness of levetiracetam with controlled-release carbamazepine and extended-release sodium valproate as monotherapy in patients with newly diagnosed epilepsy.

Objective: To compare the effectiveness of levetiracetam (LEV) with extended-release sodium valproate (VPA-ER) and controlled-release carbamazepine (CBZ-CR) as monotherapy in patients with newly diagnosed epilepsy.

Methods: This unblinded, randomised, 52-week superiority trial (NCT00175903) recruited patients (≥16 years of age) with ≥2 unprovoked seizures in the previous 2 years and ≥1 in the previous 6 months. The physician chose VPA or CBZ as preferred standard treatment; each patient was randomised to standard treatment or LEV.

Seizure outcome 1 year after temporal lobe epilepsy: an analysis of MR volumetric and clinical parameters.

Background: The aim of this work was to determine predictors that may contribute to surgical success or failure. Relevant pre- and postoperative baseline data were analyzed, and temporal structures underwent a volumetric analysis.

Methods: A total of 207 patients (107 female) underwent complete evaluation for epilepsy surgery.

Verapamil attenuates the malignant treatment course in recurrent status epilepticus.

In the scenario of refractory status epilepticus, the recommended approach of intensive care treatment is limited with respect to the available pharmacodynamic variability and its impeding, severe side effects. Alternative treatment options are therefore urgently needed. In the case described, a patient with nonlesional frontal lobe epilepsy had a high-frequency series of tonic seizures, which evolved into a malignant form of status epilepticus.

Impaired function of GABA(B) receptors in tissues from pharmacoresistant epilepsy patients.

Purpose: Effects of pre- and postsynaptic γ-aminobutyric acid B (GABA(B)) receptor activation were characterized in human tissue from epilepsy surgery.

Methods: Slices of human cortical tissue were investigated in a submerged-type chamber with intracellular recordings in layers II/III. Parallel experiments were performed in rat neocortical slices with identical methods.

Clinical neuropathology of the epilepsies in the 100 years of the ILAE (1909-2009).

The paper describes the history of the clinical neuropathology of the epilepsies in the last hundred years from microscopy to molecular neuropathology. The main focus is on the concepts of hippocampal sclerosis and its discussion of causative lesion or consequence of seizures, and the concept of developmental disturbances in respect to general epileptogenicity. Clinical neuropathology remains an important discipline in the future of epileptology and brain research especially in the area of molecular genetics.

Towards a clinico-pathological classification of granule cell dispersion in human mesial temporal lobe epilepsies.

The dentate gyrus (DG) plays a pivotal role in the functional and anatomical organization of the hippocampus and is involved in learning and memory formation. However, the impact of structural DG abnormalities, i.e.

Impact of levetiracetam add-on therapy on different EEG occipital frequencies in epileptic patients.

Unlabelled: The EEG background activity reflects the functional state of the brain. The established sensitivity of EEG to drug intoxication and in particular to antiepileptic drugs (AEDs) made that EEG has become useful as an objective measure for monitoring chronic AED therapy and in investigation of cognitive functions. Therapy with classical AEDs has become associated with slowing of EEG background rhythm and the EEG changes correlated to changes on cognitive measures.

Perioperative fluctuations of lamotrigine serum levels in patients undergoing epilepsy surgery.

Unlabelled: Some patients undergoing epilepsy surgery suffer from early postoperative seizures which may have a negative impact on later outcome. Factors contributing to these seizures have not to date been examined systematically. We hypothesized that reduction of postoperative serum levels of antiepileptic drugs (AED) may be one risk factor for early postoperative seizures.

A new clinico-pathological classification system for mesial temporal sclerosis.

We propose a histopathological classification system for hippocampal cell loss in patients suffering from mesial temporal lobe epilepsies (MTLE). One hundred and seventy-eight surgically resected specimens were microscopically examined with respect to neuronal cell loss in hippocampal subfields CA1-CA4 and dentate gyrus. Five distinct patterns were recognized within a consecutive cohort of anatomically well-preserved surgical specimens.

Carbamazepine-resistance in the epileptic dentate gyrus of human hippocampal slices.

Overexpression of drug efflux pumps at the blood brain barrier (BBB) has been suggested to be one important factor contributing to drug resistance in epilepsy. This would imply that resected brain tissue of drug-resistant patients is drug-sensitive in absence of the BBB. Here we studied the effects of carbamazepine (CBZ) at therapeutically relevant concentration on epileptiform activity electrophysiologically recorded in acute hippocampal slices of patients with mesial temporal lobe epilepsy (MTLE; 28 patients, 49 slices) or extra-hippocampal tumours (tumour; 6 patients, 11 slices).

Stimulus and potassium-induced epileptiform activity in the human dentate gyrus from patients with and without hippocampal sclerosis.

Hippocampal specimens resected to cure medically intractable temporal lobe epilepsy (TLE) provide a unique possibility to study functional consequences of morphological alterations. One intriguing alteration predominantly observed in cases of hippocampal sclerosis is an uncommon network of granule cells monosynaptically interconnected via aberrant supragranular mossy fibers. We investigated whether granule cell populations in slices from sclerotic and nonsclerotic hippocampi would develop ictaform activity when challenged by low-frequency hilar stimulation in the presence of elevated extracellular potassium concentration (10 and 12 mm) and whether the experimental activity differs according to the presence of aberrant mossy fibers.

Levetiracetam in focal epilepsy and hepatic porphyria: a case report.

We report a patient with focal epilepsy and latent hereditary coproporphyria who had exacerbation of clinical symptoms of porphyria under treatment with valproate and primidone and was then treated with levetiracetam without exacerbation of clinically latent porphyria.